The Centers for Medicare & Medicaid Services (CMS) is looking to get the word out to eligible hospitals not yet participating in the Medicare EHR Incentive Program about approaching deadlines for receiving EHR incentive payments. In order to receive EHR incentive payments in 2015 and avoid Medicare payment adjustments in 2014, EHs must keep an eye on two keep dates: April 1 and July 1.

The first is the last day for these eligible providers to begin their 90-day reporting period for the first year of Stage 1 Meaningful Use. The second is the deadline for EHs to complete their initial meaningful attestation for the EHR Incentive Programs. Here is the message from CMS:

Eligible hospitals that miss this deadline can still earn a 2015 incentive payment—and avoid the 2017 payment adjustment—if they begin their reporting period by July 1 and attest by November 30. However, they will be subject to the 2016 payment adjustment unless they apply and qualify for a hardship exception.

Hospitals that successfully attest in 2015 will also be eligible to earn a 2016 incentive if they continue to participate.

Eligible hospitals that begin participating after 2015 will not be able to earn incentive payments. They will also be subject to payment adjustments in 2016 and 2017.

There are a lot of great ICD-10 resources out there to help you with your ICD-10 transition strategies. Although, I think most hospitals are wondering if they should prepare for ICD-10 or not. Those that were getting prepared last year got burned. Now they’re likely wondering if they’re going to get burned again. Those that weren’t prepared for ICD-10 last year were saved and they’re likely hoping to be saved again.

How is your hospital approaching ICD-10? Are you going forward with ICD-10 preparation using projects that are masked as Clinical Documentation Improvement (CDI) programs? Are you in wait and see mode? Are you going full bore in preparing, training, and testing for ICD-10?

I said that last one kind of ironically. I haven’t seen any organization that’s doing that right now which is really amazing. Last year at this time, I knew a bunch of organizations that were fully engage in preparations for ICD-10. This year, no such message. Last year at this time, many were calling for ICD-10 preparation. This year, people are afraid that they’re going to be “the boy who cried wolf.” There’s only so many times you can cry ICD-10 before people stop listening. We might be there already. It’s amazing the power of uncertainty.

As I read through all of the coverage of the announcement, John Halamka seems to have shifted gears from their current in house EHR approach to now considering a switch to some other external EHR vendor. This is very interesting given this blog post by John Halamka back in 2013. Here’s an excerpt from it:

Beth Israel Deaconess builds and buys systems. I continue to believe that clinicians building core components of EHRs for clinicians using a cloud-hosted, thin client, mobile friendly, highly interoperable approach offers lower cost, faster innovation, and strategic advantage to BIDMC. We may be the last shop in healthcare building our own software and it’s one of those unique aspects of our culture that makes BIDMC so appealing.

The next few years will be interesting to watch. Will a competitor to Epic emerge with agile, cloud hosted, thin client features such as Athenahealth? Will Epic’s total cost of ownership become an issue for struggling hospitals? Will the fact that Epic uses Visual Basic and has been slow to adopt mobile and web-based approaches provide to be a liability?

Or alternatively, will BIDMC and Children’s hospital be the last academic medical centers in Eastern Massachusetts that have not replaced their entire application suite with Epic?

Based on John Halamka’s comments it seems that his belief might have changed or at least he’s considering the option that an in house system is not the right approach moving forward. No doubt Athenahealth is hoping that they’ll delay the decision a few years so they have a chance to compete for BIDMC’s business.

If you look at the rest of the blog post linked above, Halamka was making the case for Epic back in 2013. I think that clearly makes Epic the front runner for the BIDMC business at least from Halamka’s perspective. We’ll see how that plays out over time.

It seems like we’re nearing the end of the in house EHR hospital. Are there any others that still remain?

We often hear about the ways technology causes ergonomic problems for us and our health. Whether it’s wrist pain from all the typing or back pain from the way we sit or eye strain from looking at a screen all day. Technology has a number of really major challenges when it comes to ergonomics.

Unfortunately, I don’t think most hospitals have put much thought into the ergonomic impact of an EHR on their nurses and doctors. Since many of these health issues happen over time, I think we haven’t yet awoken to these problems. This is an issue that’s likely going to impact a lot of hospitals in the next 3-5 years.

Think about the potential liability a hospital could have because of a poorly done EHR implementation which causes back pain, wrist strain and kills people’s eyesight. That’s a really big deal and worth considering.

A while back I actually saw this infographic dedicated to some of the ergonomic challenges that nurses face in a hospital. We need to start talking about these topics a lot more or it’s going to grow into an enormous problem.

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